Loyal reader TrapierMichael (Trapper to his policy friends) questioned the source of a quote used in a post here earlier today attributed to the McKinsey study on CDHPs. Trapper could not find the quote in the article, but did locate it in another report, done by the folks at the Employment Benefits Research Institute, a well-respected industry group.
The EBRI study, entitled “Early Experience With High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey” was out in December of 2005; six months after the McKinsey report.
One of the key points in the original McKinsey document was this statement:
“it remains to be seen whether CDHP plans with HSAs inhibit the appropriate use of maintenance drugs and treatments for behavioral conditions…”
The EBRI study points directly to this issue, as Spike noted in his quote, albeit mis-cited. This is in conflict with the McKinsey study’s finding that “One striking finding was the increased likelihood of CDHP consumers with chronic diseases to report that they were taking greater responsibility for their health.” CDHP partipants were over 20% more likely to “carefully follow their treatment regimens.”
Of note, the companies implementing CDHPs that did not do so just to lower costs, but invested in employee education, communicated clearly, and provided access to data and information about lifestyle changes, had the most satisfied employees. The employer with the highest employee satisfaction even went so far as to start an employee fitness center, reward employees with cash for attainment of certain health goals, and extensively trained employees on the health plan itself as well as sources for health information.
The research methodology and cohort for each study was different, with EBRI using data from the Harris Interactive Study and McKinsey surveying individuals from specific employers with full-replacement CDHPs (where the old health plan was terminated and replaced in its entirety by CDHPs).
I’d like to get into more detail but I have to get some work done.
Compliments to Trapper for his research, and I’ll try to do a better job of vetting sources.

Spike has done his homework. UPDATE – well, Spike actually quoted a different report, not the original McKinsey one. I should have done some source checking, did not, and apologize for the oversight.) In response to a comment from another reader (Michael Trapier), he read the entire article by McKinsey on CDHPs et al. Here’s Spike’s quote from the article, which deserves its own post. (again, turns out this quote was from an EBRI research report), and read the comments below:
“While people reported using health services at similar rates across health plans, adults with CDHPs and HDHPs were significantly more likely to report that they had avoided, skipped, or delayed health care because of costs than were those with comprehensive insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. The survey asked whether in the last year respondents had delayed or avoided getting health care services when they were sick because of costs. About one-third of people in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, twice the rate of those in comprehensive health plans (17 percent).
Having a health problem made it more likely that people avoided or delayed care. Among people who reported being in fair or poor health or having at least one chronic health condition, those in CDHPs or HDHPs reported delaying or avoiding care at higher rates than those in comprehensive plans: 40 percent of those in CDHPs and 31 percent of people in HDHPs, compared with 21 percent in comprehensive plans. People with HDHPs and CDHPs in households with incomes of under $50,000 were also more likely to avoid or delay care: nearly half of those in CDHPs and more than two in five in HDHPs reported delaying or avoiding care, compared with one-quarter (26 percent) of those in comprehensive plans in that income range.
In addition to delaying or avoiding health care, people in HDHPs were significantly more likely to skimp on their medications than were those in comprehensive plans. The survey asked respondents whether in the last 12 months they had not filled a prescription because of costs. More than one-quarter (26 percent) of those with HDHPs said they had not filled a prescription because of cost, compared with 16 percent of those in comprehensive health plans (Figure 17). Having a health problem made it more likely that people avoided filling prescriptions, particularly those with HDHPs: One-third of those in HDHPs with health problems had not filled a prescription because of cost, compared with one-fifth (21 percent) of people in comprehensive plans.”
That’s a (rather lengthy) quote from the study you cited. In fact, that whole study talks about how total healthcare use is the same for each group, but out of pocket costs are way higher for those in CDHPs and that people in comprehensive group care found that their plan made it easier for them to incpororate costs into their decisions about treatment.
As for health economics, the reality is that as long as there is EMTALA, (which says that hospitals must treat patients in need of emergency care regardless of their ability to pay), creating systems where preventive pay is discouraged will only be more expensive for all of us. And I don’t see anybody having the political will to void EMTALA. We’re all in this together, whether you like it or not.”
That’s a lot of good work, Spike.
Notably, the time period for the study did not enable the researchers to identify changes in health care costs over time. One has to wonder if the failures to comply with drug regimens etc. would actually lead to increased health care costs over time. Actually, you don’t have to wonder.
BTW – the McKinsey report also notes that CDHPs did have a substantial correlation with participants’ awareness of costs; desire to seek alternative treatment, and likelihood of involvement in healthy behaviors. But I wonder if the latter was not an artifact, and if the participants’ healthy behaviors made it more likely that they would select CDHPs.
What does this mean for you?
More evidence that CDHPs will do nothing to reduce medical expenses.